This cohort study evaluates data from the Nurses’ Health Study II to investigate the association of occupational exposure to disinfectants and other cleaning products with the incidence of chronic obstructive pulmonary disease (COPD) among female US registered nurses with no history of COPD at baseline.

Disinfectant use has been associated with adverse respiratory effects among healthcare workers. However, the specific harmful agents have not been elucidated. We examined the association between occupational exposure to disinfectants and asthma control in the Nurses’ Health Study II, a large cohort of female nurses. Nurses with asthma were invited in 2014 to complete two questionnaires on their current occupation and asthma (response rate: 80%). Asthma control was defined by the Asthma Control Test (ACT). Exposure to major disinfectants was evaluated by a Job-Task-Exposure Matrix (JTEM). Analyses included 4,102 nurses with asthma (mean age: 58 years). Asthma control was poor (ACT=16–19) in 12% of nurses and very poor (≤15) in 6%. Use of disinfectants to clean medical instruments (19% exposed) was associated with poorly (odds ratio 1.37; 95%CI: [1.05–1.79]) and very poorly (1.88 [1.38–2.56]) controlled asthma (P-trend 0.004, after adjustment for potential confounders). Using JTEM estimates, exposure to formaldehyde, glutaraldehyde, hypochlorite bleach, hydrogen peroxide and enzymatic cleaners was associated with poor asthma control (all P-trend<0.05); exposure to quaternary ammonium compounds and alcohol was not. Use of several disinfectants was associated with poor asthma control. Our findings suggest targets for future efforts to prevent worsening of asthma control in healthcare workers.